<div id="addReportInfoBackCityModel" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel"
     aria-hidden="true">
    <div class="modal-dialog modal-lg">
        <div class="modal-content">
            <div class="modal-body">
                <h3 class="m-t-none m-b ">
                    <span><vc:i18n name="上报" namespace="addReportInfoBackCity"></vc:i18n></span>
                </h3>
                <div class="ibox-content">
                    <div>
                        <div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="姓名" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <input v-model.trim="addReportInfoBackCityInfo.name" type="text"
                                           :placeholder="vc.i18n('必填，请填写姓名','addReportInfoBackCity')"
                                           class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="身份证" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <input v-model.trim="addReportInfoBackCityInfo.idCard" type="text"
                                           @change="addReportInfoBackCityIDCardChange()"
                                           :placeholder="vc.i18n('必填，请填写身份证','addReportInfoBackCity')"
                                           class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="手机号" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <input v-model.trim="addReportInfoBackCityInfo.tel" type="text"
                                           :placeholder="vc.i18n('必填，请填写手机号','addReportInfoBackCity')"
                                           class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="来源地" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <select class="custom-select" v-model="addReportInfoBackCityInfo.source">
                                        <option selected disabled value="">
                                            {{vc.i18n('必填','addReportInfoBackCity')}}，请选择来源地
                                        </option>
                                        <option value="1001">{{vc.i18n('国内','addReportInfoBackCity')}}</option>
                                        <option value="2002">{{vc.i18n('国外','addReportInfoBackCity')}}</option>
                                    </select>
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="城市名称" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <input v-model.trim="addReportInfoBackCityInfo.sourceCityName" type="text"
                                           :placeholder="vc.i18n('必填，请填写城市名称','addReportInfoBackCity')"
                                           class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="返回时间" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <input v-model="addReportInfoBackCityInfo.backTime" type="text"
                                           :placeholder="vc.i18n('必填，请填写返回时间','addReportInfoBackCity')"
                                           class="form-control addBackTime">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-sm-2 col-form-label">
                                    <span><vc:i18n name="备注" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </label>
                                <div class="col-sm-10">
                                    <input v-model.trim="addReportInfoBackCityInfo.remark" type="text"
                                           :placeholder="vc.i18n('选填，请填写备注','addReportInfoBackCity')"
                                           class="form-control">
                                </div>
                            </div>
                            <div class="ibox-content">
                                <button class="btn btn-primary float-right" type="button"
                                        v-on:click="saveReportInfoBackCityInfo()">
                                    <i class="fa fa-check"></i>&nbsp;保存
                                </button>
                                <button type="button" class="btn btn-warning float-right" style="margin-right:20px;"
                                        data-dismiss="modal">
                                    <span><vc:i18n name="取消" namespace="addReportInfoBackCity"></vc:i18n></span>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
